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- Job Title
- Credit/Refund Specialist
- Job ID
- Nashville, TN 37205
- Other Location
The Refunds Specialist analyzes data to determine whether or not a refund is warranted, based on contractual agreements and payments received, and administers refunds accordingly. The Credit/Refund Specialist will be responsible for the expedient and accurate refund processing of patient and insurance over payments.
- Review EOBs and ensure allowances, adjustments, unallocated payments, and overpayments are posted correctly
- Reviews refund requests submitted by the billing team for accuracy, before sending to the accounting department for processing.
- Review and resolve accounts with credit balances/request refunds and/or adjustments as necessary
- Generate reports to identify outstanding credit balances and prepare overpayment packages as necessary
- Initiate and work up refund requests for overpayments
- Process refunds and credit balances to payers
- Identify account problems, patterns, and trends
- Assist with additional payment-related functions as necessary
- Assist and respond to reports in a professional manner
- Comply with state/federal regulations and adhere to HIPAA and PHI guidelines
- Identify patient accounts with credit balances to determine whether or not a refund is due to the patient and/or insurance company.
- Communicate refund status with patients/insurance companies.
- Maintains refund tracking spreadsheet for all refund requests.
- Follow up on requests submitted to ensure payment has been received.
- Post adjustment and or payment corrections to patient accounts in billing software.
- Cross trained to Perform other duties as assigned to meet business needs
Qualifications and Education Requirements
- 2+ years of experience working with medical refunds.
- High School Diploma or equivalent, Associate’s Degree preferred
- Previous healthcare billing and/or payment posting experience required.
- Basic computer knowledge (Windows, MS Word, MS Excel, Internet)
- Comfortable with computer use, online resources, and learning new software
- Understanding of Electronic Response Admittances (ERAs) and Explanation of Benefits (EOBs)
- Strong Attention to details
- 10 Key by touch.
- Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external.
- Must be able to work as part of a team.
- Knowledge of medical terminology
- Knowledge of health insurance
- Familiar with Chemotherapy and Radiation Billing
Ability to work in a team environment and be able to multi task. Strong Business and Organizational Competence. Exceptional Customer Service Skills. Strong functional Competence. Interpersonal Skill Competency. Stress Tolerance. Initiative. Adaptability. Accountability. Integrity. Self-Confidence. Time Management Skills with an emphasis on multi-tasking. Ability to maintain a professional, polished image. Ability to communicate effectively, both written and verbal.
Physical Demands and work environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: Required job duties are essentially sedentary in nature, consisting of occasional walking, standing, lifting and/or carrying twenty five pounds maximum, seeing, speaking and hearing. Must be able to lift up to 25 pounds.
Work environment: Required job duties are normally performed in a climate-controlled office environment.